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Heidi Cross's picture

By Heidi Cross, MSN, RN, FNP-BC, CWON

The United States is one of the most litigious nations in the world, with the result that numerous medical malpractice lawsuits are initiated against hospitals and other health care facilities, as well as practitioners. Commonly, these lawsuits allege that the facility failed to meet standards of care related to management of wounds including pressure injuries, failed to provide adequate nutrition, and did not properly address issues such as incontinence.

Holly Hovan's picture


Peristomal pyoderma gangrenosum (PPG) is a somewhat uncommon and challenging condition to diagnose and treat, as no evidence-based guidelines or standard treatments exist. PPG can occur after the surgical placement of an ostomy, impacting approximately 0.5 to 1.5 people per million annually, and accounts for 15% of pyoderma gangrenosum cases. Effective management of PPG requires local and often systemic immunosuppression and topical wound care, which is compatible with being applied beneath an ostomy pouch.

Christine Miller's picture

Christine Miller, DPM, PhD

Chronic venous leg ulcerations (CVLUs) are one of the most common lower extremity wounds with a recurrence rate of as high as 70%. Among the wound care community, there is a common understanding that optimal healing requires the management of tissue, infection/inflammation, and moisture balance within the wound bed, along with appropriate compression therapy. It is also vital for patients with CVLUs to be evaluated by a multidisciplinary team. This evaluation includes a comprehensive vascular evaluation from both a venous and arterial standpoint. While there has been tremendous progress in treating venous insufficiency from a surgical perspective along with advanced wound healing techniques, CVLUs are still a major hurdle to overcome.

WoundSource Practice Accelerator's picture

Wound management is a tremendous clinical challenge for many health care professionals. The World Health Organization has recognized that wound management is a worldwide public health issue best managed by an interprofessional team. This interdisciplinary approach has been shown to increase healing and decrease wound recurrence. However, it requires shared decision making with many clinicians to create an optimal care plan.

WoundSource Practice Accelerator's picture

Wound repair and regeneration comprise a complex process of biological and molecular events that consists of cell migration and proliferation, along with extracellular matrix deposition and remodeling. Unfortunately, not all wounds progress through healing easily. Certain pathophysiologic and metabolic conditions can alter the course of healing and impair or delay it, resulting in chronic, nonhealing wounds. The costs to treat nonhealing wounds can be high, and the patient’s quality of life can be impacted by any related loss of mobility or productivity. For these reasons, advanced wound care modalities and products may be introduced to help address underlying factors that impair the healing process.

WoundSource Practice Accelerator's picture

Angiogenesis: The process of new blood vessel formation. This process is required for wound healing and allows for the delivery of oxygen and nutrients to the body’s tissues.

Cellular and tissue-based therapies: Advanced therapies that may use cells to induce immunomodulation in the wound bed and facilitate healing by resolving inflammation. Such modalities may include stem cells, scaffolds, skin substitutes, and epidermal substitutes, among others.

Edematous: A term to describe wounds that are affected with edema or are abnormally swollen.

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WoundSource Practice Accelerator's picture

Chronic and complex wounds present a formidable challenge in health care. Nonhealing wounds impact approximately 1% of the world's population yet account for more than 2% to 4% of health care expenses. Wounds that require additional clinical efforts often include those that are chronic and resistant to therapy, those with increased risk, and those that reduce the patient's quality of life.

WoundSource Practice Accelerator's picture

The management of wounds, especially complex and chronic wounds, is a daunting clinical challenge. Achieving progress toward wound closure often depends on the right selection of treatment modalities for the wound and acknowledgment of any other underlying clinical considerations that present barriers to healing. However, before treatment selection, a full and accurate wound assessment must be completed. Without analyzing all variables that impact wound healing, clinicians may be unable to identify the proper treatment course.

Christine Miller's picture

Christine Miller, DPM, PhD

The role of nutrition in wound healing has been heavily explored since the early part of the 20th century. Addressing the proper balance of both macronutrients and micronutrients is a crucial part of the systemic treatment plan for patients with chronic wounds. Nutrition professionals are often highly valued members of any multidisciplinary healing team. There can often be adverse consequences of malnutrition, such as compromised immune systems and increases in hospital readmission rates. As modern-day clinicians with access to advanced therapies, we may think that adding nutrient supplementation to a care regimen is a contemporary concept, but in reality it is steeped in history.

Alex M. Aningalan's picture

Alex M. Aningalan, MSN, RN, CWON, WCC

Chronic wound conditions are prevalent across health care systems globally and often result in economic and humanistic burdens on clinicians and patients.1 Moreover, pressure injuries, among of the more common types of chronic wounds, affect an estimated 2.5 million people in the United States annually, resulting in a staggering 60,000 preventable deaths.2 In addition, the Centers for Medicare & Medicaid Service reported that the United States spends about $9.1 to $11.6 billion annually as payment for the burden imposed by pressure injuries.2